Risk of Clostridioides difficile Infection After Helicobacter pylori Treatment

Lawrence J. Leung, MD, MPH1,∗ ∙ Sophie A. Merchant, MPH2,∗ ∙ Jessica M. Badalov, MPH2 ∙ Douglas A. Corley, MD, PhD1,2 ∙ Dan Li, MD

Abstract

Background and Aims

Adverse outcomes associated with the treatment of Helicobacter pylori (H. pylori) remain poorly understood. We investigated whether H. pylori treatment was associated with an increased risk of Clostridioides difficile infection (CDI).

Methods

This retrospective cohort study included all adult members who tested positive for H. pylori between 1/1/2000 and 12/31/2020 at Kaiser Permanente Northern California. We measured the incidence of CDI after H. pylori treatment and evaluated the predictors of CDI using multivariable logistic regression.

Results

Of 139,226 individuals who tested positive for H. pylori, the incidence of CDI was 5.9/10,000 within 3 months (P=0.02) and 7.0/10,000 (P=0.003) within 6 months after H. pylori treatment, compared with 2.7/10,000 among untreated individuals. The adjusted odds ratio (aOR) (95% confidence interval [CI]) for CDI within 3 months after H. pylori treatment was 2.00 (1.02-3.90) overall, 3.15 (1.14-8.70) for concomitant therapy and 6.34 (2.75-14.59) for bismuth quadruple therapy. Inflammatory bowel disease (IBD) (aOR 7.89 [2.38-26.21]) and history of CDI (aOR 8.27 [1.92-35.62]) had the strongest association with CDI, while Asians/Pacific islanders (aOR 0.22 [0.09-0.55] and non-English language preference (aOR 0.30 [0.12-0.72]) were associated with a lower risk.

Conclusions

In a large, diverse, community-based population, treatment of H. pylori was associated with an increased risk of CDI, although the overall incidence was very low. History of IBD and prior CDI were the strongest predictors of CDI. These findings support the safety of H. pylori treatment, although caution should be exercised when treating H. pylori among individuals with IBD or prior history of CDI.

https://www.ghadvances.org/article/S2772-5723(25)00219-5/fulltext